code editing summary v1 12-18 - blue cross blue shield of … · 2003-11-14 · five-digit numeric...

Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company* Southwest Texas HMO, Inc.* d/b/a HMO Blue Texas

* Independent Licensees of the Blue Cross and Blue Shield Association

Code Editing Summary Bulletin

BlueCross and BlueShield of Texas utilizes McKesson Information Solutions code auditing software, that serves as one of the sets of guidelines for coverage decisions. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the auditing tool. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to all applicable state and/or federal law. The auditing tool does not constitute plan authorization, nor is it an explanation of benefits. BlueCross and BlueShield of Texas code auditing is not applicable to NASCO claims. These contracts are underwritten by other state plans and each plan follows their code auditing guidelines. For questions or information regarding NASCO claims, please contact NASCO Customer Service at 1-800-992-5405. HMO Blue Texas physicians who are contracted/affiliated with a capitated IPA/medical group must contact the IPA/medical group for information regarding HMO claims/reimbursement information and other general polices and procedures.


* Independent Licensees of the Blue Cross and Blue Shield Association 2

Copyright notice

Copyright © 2002 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.

Use of this documentation and related software is governed by a license agreement. This documentation contains confidential, proprietary and trade secret information of the McKesson Corporation and/or one of its subsidiaries and is protected under United States and international copyright and other intellectual property laws. Use, disclosure, reproduction, modification, distribution, or storage in a retrieval system in any form or by any means is prohibited without the prior express written permission of the McKesson Corporation and one/or all of its subsidiaries. This documentation is subject to change without notice.

Physicians’ Current Procedural Terminology (CPT)

CPT is a registered trademark of the American Medical Association.

Physicians’ Current Procedural Terminology (CPT) is a listing of descriptive terms and five-digit numeric identifying codes and modifiers for reporting medical procedures performed by physicians. This presentation includes only CPT descriptive terms, numeric identifying codes, and modifiers that were selected by the McKesson Corporation and/or one of its subsidiaries in this product. No fee schedules, basic unit values, relative value guides, guidelines, conversion factors, or scales are included in the Physicians’ Current Procedural Terminology (CPT).

Any five-digit numeric CPT codes, service descriptions, instructions and/or guidelines are copyright © American Medical Association. All rights reserved.

Disclaimers The AMA assumes no responsibility for the consequences attributable to or related to any use or interpretation of any information contained in or not contained in this product. Neither the McKesson Corporation and/or one of its subsidiaries nor AMA directly or indirectly practices medicine or dispenses medical services.

Publication date

First Edition, November 2002 Printed in U.S.A.

U.S. Patent Number

5,253,164



Version

Code Editing Summary Bulletin – Version 1.0

McKesson Information Solutions publication number Document ID CESB0101102

Corporate address McKesson Information Solutions 5995 Windward Parkway Alpharetta, GA 30005 (404) 338-6000.

Trademarks

ClaimCheckand the McKesson Information Solutions logo are registered trademarks of McKesson Information Solutions, Inc.

All other product and company names may be trademarks or registered trademarks of their respective companies.



Table of Contents

About this Publication..............................................................................................................5 Overview .............................................................................................................................5 Audience and purpose .........................................................................................................5 Guidelines for use................................................................................................................5 Content overview ................................................................................................................6 Code auditing – industry overview......................................................................................6 Clinical knowledge base development policy .....................................................................7 What’s in this publication?..................................................................................................8 To obtain help and submit suggestions ...............................................................................8

1 – ClaimCheck .......................................................................................................................9 Overview .............................................................................................................................9 Age conflict .......................................................................................................................10 Alternate code recommendation........................................................................................11 Assistant at surgery ...........................................................................................................12 Cosmetic............................................................................................................................12 Duplicate ...........................................................................................................................13 Evaluation and management services................................................................................16 Gender conflict ..................................................................................................................18 Incidental...........................................................................................................................18 Modifiers ...........................................................................................................................19 Mutually exclusive ............................................................................................................20 Obsolete.............................................................................................................................20 Rebundling ........................................................................................................................21 Unlisted .............................................................................................................................22



About this Publication

Overview

This publication presents a summary of the edits used by BlueCross and BlueShield of Texas inherent in McKesson’s code auditing products along with supporting illustrations.

Audience and purpose

The purpose of the Code Editing Summary Bulletin is to familiarize physicians and providers with Blue Cross and Blue Shield of Texas claim editing methodologies including edit definitions with specific examples to illustrate the edit.

This information is supplied to assist physicians and providers in:

• understanding the editing methodology of Blue Cross and Blue Shield of Texas code auditing system

• understanding the coding methodologies, bundling processes, and other policies used to analyze claims for covered services submitted for payment.

Guidelines for use

This publication is intended for use or disclosure solely for the purpose of practice management or billing activities. In accord with the Texas Department of Insurance regulation, this publication may not be used to:

• Misrepresent the level of services actually performed

• Determine covered benefits for specific enrollees

• Dictate the types of practices, policies, or procedures that relate to or affect the claims payment process that a health plan may elect to use

• Prescribe, designate, or limit access to medical care



Content overview

Because of the design of Blue Cross and Blue Shield of Texas auditing system, claims are processed efficiently and consistently. The software purchased by BCBSTX developed its editing logic and rules utilizing various industry and government sources. In the edit types cited in this publication, the software makes coding recommendations based on the more than likely scenario and/or the more comprehensive procedure. The code auditing products are not designed to address unusual circumstances that may make an encounter unique. At times, only the appeal and review process can determine when exceptions exist.

Code auditing – industry overview

In the U.S. today, consumers spend more than $1 trillion annually on healthcare. Unfortunately, many of those dollars are mis-spent because they are lost due to coding inaccuracy, inappropriate billing, and poor administrative practices. These have been major issues impacting the healthcare industry for some time, each of which is addressed by an automated code auditing system.

These automated tools are used by payor organizations to automate their existing medical policies and guidelines to:

• Pay claims appropriately and accurately

• Apply consistent payment policies across providers

• Enhance operational efficiencies and therefore reduce costs

• Decrease claims suspensions and increase processor productivity

Code auditing tools are not designed to establish an organization’s medical policy and, therefore, are not independent claims payment tools. Each payor organization is responsible for determining appropriate reimbursement for individual provider claims based on their benefits, coverage, medical, and reimbursement policies.

The health insurance industry has become dependent upon the use of standardized coding systems as the primary mechanism to determine appropriate reimbursement. Much time and effort has been invested in the development of comprehensive coding systems which assign unique “code” numbers to every health care related procedure, service, or product. Reasonable fees or relative value units for each code are determined, turning the coding system into a reimbursement system. This evolution to coding-based reimbursement systems gained increasing momentum over the past 15 years largely due to the obvious advantages it represented in administrative efficiency and health care cost containment.



Our software vendor developed its automated code auditing systems in response to the concerns that the billing code error problem could not effectively be solved through increased education of providers, health insurance claims examiners, and adjudicators. Individual providers or claims examiners could not be expected to provide the high level medical expertise and coding knowledge required to identify and correct all occurrences of billing code error problems. In 2003, the annual coding system updates will include approximately 709 new, 682 revised, and 361 deleted/invalid codes. These annual coding system changes contribute to code error problems that can be supported by code auditing systems.

Providers are responsible for determining the codes that best describe the health care products or services provided. A claim can be coded properly from the standpoint of coding guidelines and still represent a procedure or service that should not be reimbursed. The introduction to the Current Procedural Terminology (CPT) manual published by the American Medical Association even states, “Inclusion or exclusion of a procedure does not imply any health insurance coverage or reimbursement policy.” Each payor has unique reimbursement guidelines that are utilized to determine eligibility for reimbursement.

Code auditing systems are designed to assist data entry clerks, claims examiners, and medical coders in the submission and processing of health care encounters and claim forms. These systems utilize specialized knowledge bases and software that allow users to apply clinical rules and guidelines that assure adherence to industry standards with regard to the appropriate billing of healthcare services and procedures.

Health care payors and providers use code auditing systems to increase productivity, assure accurate and appropriate claims payment on a timely basis, and reduce administrative costs. These benefits accrue directly to the health care consumer who would otherwise bear additional costs. Specifically, when automated code auditing tools are used to assure accurate and appropriate payment, control is maintained over potentially inappropriate payments, manual intervention is eliminated, and claims are paid consistently and promptly.

Clinical knowledge base development policy

The clinical knowledge base, containing the edits, reflects the current state of health care delivery supported by fact and science. Evaluation of external and internal resources of input, including relevant, internally derived data, is completed to develop the knowledge base. The clinical knowledge base supports correct coding and utilization initiatives, while minimizing manual handling and rework.

Sources of information used are reputable references from generally recognized and authoritative materials including, but not limited to:

• “Current Procedural Terminology” (CPT)



• Specialty society coding guidelines

• Medicare Correct Coding Initiative

Overriding considerations, during code edit development, include determination of the most likely clinical scenario and determination of the most clinically intense procedure (e.g., to determine a primary vs. secondary procedure submitted on a claim).

The clinical knowledge bases are developed to allow for easily referenced edits, reinforce correct coding, and minimize administrative burden.

The code auditing systems are designed with customization utilities that allow organizations to manage the knowledge base content.

What’s in this publication?

The Code Editing Summary Bulletin contains the following section for your review.

Section Title Description

1 ClaimCheck Edit definitions, examples, and edit explanations presented for ClaimCheck.

To obtain help and submit suggestions

Contact Blue Cross and Blue Shield of Texas for assistance using any of the following methods:

• E-mail: [email protected]

• FAX: Pre-Service Allowed Benefit Disclosure Request

972-766-0371

• Correspondence: Pre-Service allowed Benefit Disclosure Request

PO Box 650489

Dallas, Texas 75268-0489



1 – ClaimCheck

Overview

ClaimCheck is a clinically based, expert software system that evaluates claim information to detect coding irregularities, conflicts, or errors and makes recommendations for correction.

ClaimCheck uses rule-based logic to:

• Assess provider claims information including CPT/HCPCS procedure codes against a series of edit programs.

• Recommend CPT/HCPCS procedure codes. Payor payment is based on the recommended code. The integrity of the claim is not altered.

In this section

This section contains information on the ClaimCheck edits.

Topic See Page

Age conflict 10

Alternate code recommendation 11

Assistant at surgery 12

Cosmetic 12

Duplicate 13

Evaluation and management services 16

Gender conflict 18

Incidental 18

Modifiers 19

Mutually exclusive 20



Topic See Page

Obsolete 20

Rebundling 21

Unlisted 22

Structure

For each ClaimCheck edit presented in this section, information is organized as follows:

Edit name Identifies the edit type

Definition Defines the edit

Example Example to demonstrate the edit

Code(s) Code description(s) Status

• CPT/HCPCS procedure code(s)

• Description of the procedure code(s)

• Indicates the status of each procedure in the example: Allow/Disallow/Review

Explanation Explains the procedure’s “Status” in the example.

Age conflict

Definition:

The Age Conflict edit occurs when an age-specific procedure code is assigned to a patient whose age is outside the designated age range for that procedure.

Example: Code Description Status

19030 Injection procedure only for mammary ductogram or galactogram

Disallow

Explanation: • Procedure 19030 is submitted for a 10 year-old patient.

• Procedure 19030 is an adult procedure; age should be over 14 years.

• Procedure 19030 receives an error status message, indicating an error in the claim information.



Alternate code recommendation

Definition:

The Alternate Code Recommendation edit identifies an “alternate” procedure code that will be recommended for addition to a claim when a discrepancy is detected between a submitted procedure code and the patient’s age or gender relative to that procedure code. Payment is based on the appropriate code, the claim integrity is not altered.

Example 1: Code Description Status

42825 Tonsillectomy, primary or secondary; under age 12 Disallow

42826 Tonsillectomy, primary or secondary; age 12 or over Allow

Explanation:

• Procedure 42825 is submitted for a 16 year-old patient.

• Procedure 42825 is used to report the intraoral surgical removal of the tonsils for a patient less than 12 years of age.

• Procedure 42826 is recommended as a replacement for 42825 as the correct procedure code for a patient age 12 and over.


53600 *Dilation of urethral stricture by passage of sound or urethral dilator, male; initial

Disallow

53660 *Dilation of female urethra including suppository and/or instillation; initial

Allow

Explanation: • Procedure 53600 is submitted for a female patient.

• Procedure 53600 is used to report the dilation of urethral stricture by passage of sound or urethral dilator for a male patient.

• Procedure 53660 is recommended as a replacement for procedure code 53600 as the correct procedure code for a female patient.



Assistant at Surgery

Definition:

The Assistant Surgeon edit identifies procedures not requiring an assistant-at-surgery.


67311-80 Strabismus surgery, recession or resection procedure; one horizontal muscle

Disallow

Explanation:

• Procedure 67311 indicates that the eye has not previously been operated on. After an incision is made in the conjunctiva, dissection of the medial or lateral rectus muscle is accomplished.

• Procedure 67311 is not sufficiently complex or extensive to warrant an assistant surgeon.

Cosmetic

Definition:

The Cosmetic edit identifies a procedure that is typically performed for cosmetic reasons. Cosmetic determination is made based on member contract and Medical Policy.


11200 *Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions

Review

Explanation: • Procedure 11200 is used to report removal of up to fifteen (15) fibrocutaneous skin

tags on any area of the body. Removal can be performed by scissoring or any sharp method, ligature strangulation, electrosurgical destruction or combination of treatment modalities including chemical or electrocauterization of the wound. Local anesthesia may be used.

• Procedure code 11200 may be a cosmetic procedure and a review of additional information is recommended.



Duplicate

Definition:

A Duplicate edit occurs when a procedure code description contains terminology that does not warrant multiple submissions of that procedure for a single date of service.

This includes the following terms:

• Bilateral

• Unilateral/bilateral

• Single/multiple

A Duplicate edit also occurs when a procedure is submitted multiple times, exceeding the maximum allowance that would be clinically appropriate.


76092 Screening mammography, bilateral (two view film study of each breast)

Allow

76092 Screening mammography, bilateral (two view film study of each breast)

Disallow

Explanation: • Procedure 76092 is performed to detect unsuspected cancer and is inherently

bilateral.

• Procedure code 76092 is a bilateral code and the duplicate submission of the procedure code is not warranted.


47600 Cholecystectomy; Allow

47600 Cholecystectomy; Disallow

Explanation:

When the procedure 47600 is submitted a second time on a single date of service, it is not warranted as this procedure can only be performed once in a patient’s lifetime.




29805-RT

Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure)

Allow

29805-LT

Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure)

Allow

32440-RT

Removal of lung, total pneumonectomy; Disallow

32440-LT

Removal of lung, total pneumonectomy; Allow

Explanation: • Procedure 29805 is used to report a diagnostic shoulder arthroscopy. This procedure

can be performed once per side on a single date of service. Therefore, both submissions of the code would have the “allow” status.

• Procedure 32440 is used to report the removal of an entire lung. When submitted twice on a single date of service, the second submission of the procedure code is not warranted based on a determination that it is not clinically appropriate.


26250-F1

Radical resection, metacarpal; (e.g., tumor) Allow

26250-F1

Radical resection, metacarpal; (e.g., tumor) Disallow

Note: -F1 modifier, left hand, second digit

Explanation:

Procedure 26250 is used to report radical resection of the metacarpal. Although the procedure code is valid with modifier -F1, the procedure can be performed only once per date of service based on a determination of clinical appropriateness. Therefore, the second submission of procedure 26250-F1 is not recommended.




80055 Obstetric panel: this panel must include the following: hemogram, automated, and manual differential WBC count (CBC) (85022) or hemogram and platelet count, automated, and automated complete differential WBC count (CBC) (85025) hepatitis B surface antigen (HBSAG) (87340) antibody, rubella (86762) syphilis test, qualitative (e.g. , VDRL, RPR, ART) (86592) antibody screen, RBC, each serum technique (86850) blood typing, ABO (86900) and blood typing, RH (D) (86901)

Allow

80055 Obstetric panel: this panel must include the following: hemogram, automated, and manual differential WBC count (CBC) (85022) or hemogram and platelet count, automated, and automated complete differential WBC count (CBC) (85025) hepatitis B surface antigen (HBSAG) (87340) antibody, rubella (86762) syphilis test, qualitative (e.g. , VDRL, RPR, ART) (86592) antibody screen, RBC, each serum technique (86850) blood typing, ABO (86900) and blood typing, RH (D) (86901)

Review

Explanation:

Procedure 80055 is an obstetric panel. When submitted more than once on a single date of service, a review of documentation may be required to substantiate the performance of the duplicate obstetric panel.



Evaluation and management services

Definition:

One (1) type of edit is associated with evaluation and management services:

• Global surgery period

Global surgery

Procedures that are assigned a 90-day global surgery period are designated as major surgical procedures; those assigned a 10-day or 0-day global surgery period are designated as minor surgical procedures.

• Evaluation and management services (90-day), submitted with major surgical procedures, (1-day) pre-operatively, on the same date of service or during the 90-day post-operative period, are not recommended for separate reporting because they are part of the global service.

• Evaluation and management services (10-day), submitted with minor surgical procedures, (10-day) on the same date of service or during the 10-day post-operative period, are not recommended for separate reporting because they are part of the global service.

• Evaluation and management services, submitted for “established” patients with minor surgical procedures (0-day), are not recommended for separate reporting on the same date of service because they are part of the global service and because there is an inherent evaluation and management service component included in all surgical procedures. This guideline also applies for submitted evaluation and management services that do not differentiate between “new” or “established” patients in the procedure code description.

• Services submitted for a “new” patient visit or an “initial” patient visit typically exceed services included in 0-day surgical procedures. Therefore, separate reporting of evaluation and management services for new patients or initial patient visits is recommended.



Example 1 (global surgery): Code Description Status

69000

DOS=05/20/02

*Drainage external ear, abscess or hematoma; simple Allow

99213

DOS=05/24/02

Office or other outpatient visit for the evaluation and management of an EST patient, which requires at least two of these three key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity. Counseling & coord of care w/ other providers or agencies are provided consistent w/ nature of problem(s) & patient's &/or family's needs. Problem(s) are low/moderate severity. Physicians spend 15 min face-to-face w/ patient &/or family.

Disallow

Explanation: • Procedure 69000 (10-day global surgery period) is used to report simple drainage of

an abscess or hematoma of the external ear.

• Procedure 99213 is used to report an evaluation and management service provided to an established patient during an outpatient office visit.

• When a minor surgical procedure is performed, the evaluation and management service is included in the global surgical period.

Notes: Modifier -24 is used to report an unrelated evaluation and management service by the same physician during a post-operative period. Modifier -25 is used to report a significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure. Modifier -79 is used to report an unrelated procedure or service by the same physician during the post-operative period. When these modifiers are submitted with an evaluation and management service on the same date of service or during the post-operative period by the same physician, separate reporting of the evaluation and management service may be allowed.



Gender conflict

Definition:

The Gender Conflict edit occurs when a gender-specific procedure code is incorrectly assigned based on the gender of the patient referenced on the claim.


58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);

Review

Explanation: • Procedure 58150 is submitted for a male patient.

• Procedure 58150 is used to report the removal of the uterus and cervix and one or both ovaries and one or both of the fallopian tubes.

• Procedure 58150 is not indicated for a male.

• Procedure 58150 receives an error status message indicating an error between the code and the claim information.

Incidental

Definition:

The Incidental edit identifies a procedure(s) that is performed at the same time as a more complex primary procedure and is clinically integral to the successful outcome of the primary procedure.


25101 Arthrotomy, wrist joint; with joint exploration, with or without biopsy, with or without removal of loose or foreign body

Allow

64721 Neuroplasty and/or transposition; median nerve at carpal tunnel Disallow

Explanation: • Procedure 25101 involves a surgical incision into the wrist joint for the purpose of

exploration. The joint is thoroughly explored and a biopsy may be taken. This procedure also includes the removal of loose or foreign bodies when indicated.



• Procedure 64721 includes the decompression or freeing of the median nerve from scar tissue, including external neurolysis and/or transposition. The components of this procedure are utilized in the treatment of carpal tunnel syndrome.

• When the performance of neuroplasty decompression or the freeing of an intact nerve is reported with a more comprehensive surgical procedure of the upper extremity, it is considered an integral component of the primary procedure and necessary for the successful outcome of that procedure.

Modifiers

Definition:

Edits exist for procedures that are submitted with the following modifiers:

• -80, -81, -82, -RT, -LT, E1-E4, FA-F9, TA-T9, -LC, -LD, and –RC.

Modifier Description Edit Definition

-80,-81,-82 Assistant Surgeon Refer to “Assistant surgeon” example.

-RT

-LT

• Right side of body

• Left side of body

Refer to “Duplicate” example.

E1-E4, FA-F9, TA-T9, -LC,-LD,-RC

Eyelids, digits, fingers, phalanges, carpals, metacarpals, toes, tarsals, metatarsals, left circumflex artery, left anterior descending artery, right coronary artery

Refer to “Duplicate” example.

-26

-TC

• Professional Component

• Technical Component

Refer to “Duplicate example.”



Mutually exclusive

Definition:

The Mutually Exclusive edit identifies combinations of procedures that differ in technique or approach but lead to the same outcome. This includes: a combination of procedures that may be anatomically impossible; represent overlapping and/or duplication of services; or are reported as both an initial and subsequent service. Generally, an open surgical procedure and closed procedure in the same anatomic site will be mutually exclusive.


58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);

Allow

58260 Vaginal hysterectomy; Disallow

Explanation:

• Procedure codes 58150 and 58260 are submitted on a claim.

• Procedures 58150 and 58260 are considered mutually exclusive because both procedures accomplish the same clinical outcome, using different approaches.

• Procedure 58150 is recommended for separate reporting because it is the more clinically intense procedure.

Obsolete

Definition:

The Obsolete edit identifies a procedure that is no longer performed under prevailing medical standards.


30210 *Displacement therapy (Proetz type) Review

Explanation: • Procedure 30210 is no longer performed under prevailing medical standards and is

considered obsolete. When submitted, this procedure is flagged for review.



Rebundling

Definition:

The Rebundling edit identifies procedure unbundling, which occurs when two or more procedure codes are used to report a service when a single, more comprehensive procedure code exists that represents the service submitted.

To correct this type of coding error, the unbundled procedure code(s) is rebundled to the comprehensive procedure code.

Occasionally, the procedure code that most accurately represents the services submitted will be recommended as an alternate code. Payment is based on the appropriate code, the claim integrity is not altered.


42821 Tonsillectomy and adenoidectomy; age 12 or over Allow

42826 Tonsillectomy, primary or secondary; age 12 or over Disallow

Explanation: • Procedure 42821 describes the surgical removal of the tonsils and adenoids for a

patient age 12 and older.

• Procedure 42826 is the same as that described above for removal of tonsils, only no adenoidectomy is performed.

• Procedure 42821 includes both the tonsillectomy and the adenoidectomy and more accurately describes the complete service performed.




27705 Osteotomy; tibia Disallow

27707 Osteotomy; fibula Disallow

27709 Osteotomy; tibia and fibula Allow

Explanation: • Procedure 27705 is used to report an osteotomy of the tibia. Following incision and

exposure of the bone, proper alignment of the bone is achieved by a cut that is made through the tibia. Fixation by screws or plates may be applied to maintain position.

• Procedure 27707 is used to report an osteotomy of the fibula. Following incision and exposure of the bone, proper alignment of the bone is achieved by a cut that is made through the fibula. Fixation by screws or plates may be applied to maintain position.

• Procedure 27709 is used to report an osteotomy of the tibia & fibula. This procedure represents the comprehensive procedure and is recommended on the claim.

Unlisted

Definition:

The Unlisted review flag identifies procedure codes that include the word, “unlisted”, in the procedure code description. Unlisted procedure codes should not be used when a more descriptive procedure code representing the service provided is available.


21499 Unlisted musculoskeletal procedure, head Review

Explanation: • Procedure 21499 is an unlisted musculoskeletal procedure of the head.

• A review of additional information is recommended when this procedure code is submitted to validate that a more accurate procedure code to describe the service provided is not available.

code editing summary v1 12-18 - blue cross blue shield of … · 2003-11-14 · five-digit numeric...

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